Regional anatomy of thorax 山东大学医学院解剖教研室李振华. Parts and regions of the thorax Boundaries Superiorly － jugular notch, sternoclavicular joint, superior

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Regional anatomy of thorax

山东大学医学院解剖教研室李振华


Parts and regions of the thorax

Boundaries Superiorly － jugular notch,

sternoclavicular joint, superior border of clavicle, acromion, spinous processes of C7

Inferiorly － xiphoid process, costal arch, 12th and 11th ribs, vertebra T12

Regions Thoracic wall Thoracic cavity


Landmarks of thorax Jugular notch corresponds with

The 2th thoracic vertebra in male, the 3th thoracic vertebra in female

Sternal angle corresponds with Connects 2nd costal cartilage later

ally The lower border of 4th thoracic ve

rtebra The bifurcation of trachea in the ad

ult The beginning of aortic arch which

ends posteriorly at the same level The esophagus is crossed by the l

eft main bronchus


Landmarks of thorax Xiphoid process － xiphister

nal synchondrosis lies opposite the body of the 9th thoracic vertebra

Clavicle Inferior fossa of clavicle Coracoid process

Ribs and intercostal spaces Costal arch

Infrasternal angle Xiphocostal angle

Papillae


Thoracic wallSuperficial structures Skin Superficial fascia

Superficial aa. Superficial vv.

Thoracoepigastric v. Lateral thoracic v.

Superficial nn. Supraclavicular n. Anterior and lateral cutaneous br

anches of intercostal n.


Lymphatic drainage of breast Into pectoral ln. from lateral and c

entral parts of breast Into apical and supraclavicular ln.

from superior part of breast Into parasternal ln. from medial p

art of breast Into interpectoral ln. from deep p

art of breast The lymphatic capillaries of breast

form an anastomosing network which is continuous across the midline with that of the opposite side and with that of the abdominal wall


Thoracic wallDeep structures Deep fascia

Superficial layer Deep layer—clavipectoral fascia

Muscles of thorax Subclavius Pectoralis major Pectoralis minor Serratus anterior Intercostales externi Intercostales interni Intercostales intimi

Endothoracic fascia 胸内筋膜


Intercostal space

Posterior intercostal v.

Posterior intercostal a.

Intercostal n.

Technique for thoroacocentesis(in midaxillary line)

Intercostal nerve block


Internal thoracic vessels Internal thoracic a.&v.

胸廓内动脉和静脉 Descends into thorax 1.2cm lat

eral to edge of sternum Ends at the sixth costal cartilag

e by dividing musculophrenic and superior epigastric arteries

Parasternal ln. 胸骨旁淋巴结


The Mediastinum 纵隔


The Mediastinum 纵隔

Concept All of organs between the left and

right mediastinal pleurae is called mediastinum.

It extends from the sternum in front to the vertebral column behind, and from the thoracic inlet above to the diaphragm below.


Subdivisions of mediastinum

Superior mediastinum 上纵隔 Inferior mediastinum 下纵隔

Anterior mediastinum 前纵隔 Middle mediastinum 中纵隔 Posterior mediastinum 后纵隔


Left side of mediastnum 纵隔左侧面

Root of lung

Pericardium

Phrenic n. & pericardiacophrenic a.

Left vagus n.

Left recurrent n.Thoracic aorta

Sympathetic trunk

Greater splanchnic n

Aortic arch

Thoracic ductLeft subclavian a.

Esophagus


Right side of mediastnum 纵隔右侧面

Root of lung

Pericardium

Superior vena cava

Phrenic n. & pericardiacophrenic a.

Right vagus n.

Azygos v.

Sympathetic trunk

Esophagus

Arch of azygos v.

Trachea

Inferior vena cava


Superior mediastinum 上纵隔



Locating － from inlet of thorax to plane extending from level of sternal angle anteriorly to lower border of T4 vertebra posterioly

Contents Superficial layer

Thymus Three veins

Left brachiocephelic v. Right brachiocephelic v. Superior vena cava


Superior mediastinum 上纵隔Contents Middle layer

Aotic arch and its three branches

Phrenic n. Vagus n.



Contents Posterior layer

Trachea Esophagus Thoracic duct


Relations of aortic arch Anteriorly and to the left

Pleura Lung Phrenic n. Pericardiacophrenic vessels Vagus n.

Posteriorly and to the right Trachea Esophagus Left recurrent n. Thoracic duct Deep cardiac plexus


Relations of aortic arch Superiorly

Its three branches Left brachiocephalic v. thymus

Inferiorly Pulmonary a. Arterial ligament Left recurrent n. Left principal bronchus Superficial cardiac plexus


Triangle of ductus arteriosus 动脉导管三角

Boundaries Phrenic n. Left vagus n. Left pulmonary a.

Contents Arterial ligament Left recurrent n. Superficial cardiac plexuses


Triangle of ductus arteriosus 动脉导管三角


Inferior mediastinum 下纵隔


Inferior mediastinum 下纵隔

Anterior mediastinum 前纵隔 Location － posterior to body of sternu

m and attached costal cartilages, anterior to heart and pericardium

Contents Fat Remnants of thymus gland Anterior mediastinal lymph nodes


Inferior mediastinum 下纵隔Middle mediastinum 中纵隔 Location － between anterior medias

tinum and posterior mediastinum Contents

Heart and pericardium Beginning or termination of great v

essels Phrenic nerves Pericardiacophrenic vessels Lymph nodes


Inferior mediastinum 下纵隔Posterior mediastinum 后纵隔 Location － posterior to heart and p

ericardium, anterior to vertebrae T5－ T12


Inferior mediastinum 下纵隔Posterior mediastinum 后纵隔

Contents: Esophagus Vagus n. Thoracic aorta Azygos system of veins Thoracic duct Thoracic sympathetic trunk Posterior mediastinal lymph nodes


Relations of esophagus

Anteriorly Trachea

Bifurcation of trachea

Left principal branchus

Left recurrent n.

Right pulmonary a.

Anterior esophageal plexus

Pericardium

Left atrium

Diaphragm



Posteriorly Posterior esophageal plexus Thoracic aorta Thoracic duct Azygos v. Hemiazygos v. Accessory hemiazygos v. Right posterior intercostal v.



Left Left common carotid a. Left subclavian a. Aortic arch Thoracic aorta Superior part of thoracic duct

Right Arch of azygos v.


Relations of thoracic aorta

Anteriorly Left root of lung Pericardium Esophagus

Posterior Hemiazygos v. Accessory hemiazygos v.

Right Azygos v. Thoracic duct

Left － mediastinal pleura


Mediastinal spaces 纵隔间隙 Retrosternal space 胸骨后间隙 lie

s beween sternum and endothoracic fascia

Pretracheal space 气管前间隙 lies within superior mediastinum, between trachea, bifurcation of trachea and aortic arch

Retroesophagus space 食管后间隙 lies within superior mediastinum, beween esophagus and endothoracic fascia


★You must identify follow structures ！

Thoracic wall Intercostales externi Intercostales interni Posterior intercostal a. Intercostal n. Internal thoracic a. Diaphragm

Central tendon Aortic hiatus Esophageal hiatus Vena cava foramen

Costodiaphragmatic recesse

Superior mediastinum Left brachiocephelic v. Right brachiocephelic v. Superior vena cava Aortic arch

Brachiocephalic trunk Left common carotid artery Left subclavian a.

Phrenic n. Vagus n. Left recurrent n. Arterial ligament Trachea


★You must identify follow structures ！

Middle mediastinum Pericardium Phrenic nerves Posterior mediastinum Esophagus Vagus n. Thoracic aorta Azygos veins Thoracic duct Thoracic sympathetic trunk Greater splanchnic n

Lung Apex of lung Base of lung Hilum of lung Root of lung Cardiac notch Lingual in left lung Horizontal and oblique fissures Superior, middle and inferior l

obs of right lung Superior and inferior lobs of lef

t lung

Documents

Regional anatomy of thorax 山东大学医学院 解剖教研室 李振华. Parts and regions of the thorax Boundaries Superiorly － jugular notch, sternoclavicular joint, superior

Regional anatomy of thorax 山东大学医学院解剖教研室李振华. Parts and regions of the thorax Boundaries Superiorly － jugular notch, sternoclavicular joint, superior